MUNIGI, DEMOCRATIC REPUBLIC OF CONGO — Esther Mwema thought her four-year-old son had chickenpox. He was lucky to be able to get a medical examination in this refugee camp, where many families live in tents and even clean water is scarce.
But the diagnosis was different: Mpox, a virus that is spreading in the east of the Democratic Republic of Congo, Uganda and beyond. This is already the second strain of Mpox to hit the Democratic Republic of Congo hard. The first strain spread in 2022 and was transmitted mainly through sexual contact. The new strain is spreading rapidly through close contact in everyday life, this time infecting adults, but increasingly also children.
Data from different health and government sources are often contradictory, but one thing is clear: children are now bearing the brunt. Data from the United Nations Children’s Fund shows that 84% of people who have died from MPOX in the Democratic Republic of Congo since January were children. These figures are based on a total of about 15,600 cases of the virus.
Tam Berger of Medair, an aid organization that provides medical assistance in crisis-stricken countries, says that 70 percent of the more than 300 people believed to be infected with Mpox in Munigi are children under the age of 10.
From the Democratic Republic of Congo, the virus has spread across the border to Uganda. Officials there say the outbreak is well under control, but local health workers consider the situation to be catastrophic.
“You find someone with blisters all over their body, oozing pus,” says Jovia Biira, a midwife sent by the Ugandan government to the border with the Democratic Republic of Congo as part of a monitoring team for Mpox. “Some have very high temperatures, 38 degrees Celsius and more.”
But Emmanuel Ainebyoona, spokesman for the Ugandan Ministry of Health, asked the Global Press Journal to ignore the information from border residents. There are only four confirmed cases of Mpox, he says.
More than 7 million people in the Democratic Republic of Congo, a country of around 105 million, are displaced, and many live in camps like Munigi, where Mwema is one of thousands. It was created for people escaping violence between armed groups and the official DRC military that has led to killings and destruction of property with almost or total impunity. Social distancing is difficult in the camp. Raw sewage flows through gutters along the streets and sidewalks. Water is scarce, making handwashing a challenge. It is an ideal place for Mpox and other dangerous viruses to emerge and spread.
While 35 countries worldwide reported cases of MPOX last month, the Democratic Republic of Congo was the hardest hit, accounting for an estimated 90% of all cases in Africa this year, according to the European Centre for Disease Prevention and Control. Around the city of Goma, some health centres are overwhelmed, with patient intake exceeding their capacity by 4,000%, according to a report by the international non-governmental organisation Save the Children.
Mwema and her family moved to Munigi a year ago from Rutshuru, a town about 70 kilometers northeast. Violent clashes between the notorious armed group M23 and the Congolese army, known by its French acronym FARDC, forced them to leave their hometown.
Although the family found a fragile peace in the camp, another danger existed: a highly contagious, potentially deadly virus that can only be prevented by avoiding contact with infected people.
This has happened before. New viruses, infections and diseases have emerged here or spread rapidly after their arrival. This includes Ebola, which has broken out more than a dozen times in recent decades. One reason for outbreaks is deforestation and the transmission of pathogens through close contact between humans and wild animals. Another is severe armed conflict that forces people into overcrowded camps. Another is the ongoing lack of vaccines or delays in their delivery. The fragile health system, already battered by other health emergencies and severe shortages of staff and materials, is under enormous strain. Overall, the people of the Democratic Republic of Congo are ill-equipped to deal with viral outbreaks.
Mpox exists in two main strains or clades. Clade I, which is endemic to Central and East Africa and spreads through close contact in everyday life, causes more severe disease. In previous outbreaks, about 10% of those infected died. Clade II, which is endemic to West Africa, can also spread through close contact between people or animals, but typically spreads through sexual contact. This disease is also milder, with 99.9% of people surviving.
The current outbreak of the more dangerous Clade I followed a global outbreak of Clade II in 2022.
Although Mpox belongs to the same family of viruses as smallpox, it is not nearly as deadly. However, it does pose other challenges.
One reason smallpox was eradicated in 1980 was because the virus only infected humans. Animals were never involved in its spread, says Jessica Malaty Rivera, an epidemiologist and senior advisor for science communications at the de Beaumont Foundation, a US-based health organization. Smallpox, on the other hand, has a wide range of animal pathogens.
“If smallpox becomes as catastrophic as smallpox – which I hope never will be the case – it will never be eradicated because it affects animals,” she says.
At the border between the Democratic Republic of Congo and Uganda, the transition from Clade II to Clade I is clearly visible, health workers say. Hellen Kabugho, a nurse at a CARE PLUS pharmacy in Bwera, a border town in Uganda, says she has been treating people with MPOX symptoms for several months, but the situation is changing. While only two cases have been confirmed at the hospital in Bwera, more and more people are suspected of having the virus.
Both strains can spread easily, says Kabugho. “We use the same latrines in the market, so it’s easy to get infected.”
Due to the activity at the border, it is difficult to track down people with symptoms.
“Physical contact is the order of the day because the border is very crowded and there are lots of people coming and going,” she says. “We often mix.”
Health officials in Kampala, Uganda’s capital, downplayed the outbreak, telling the Global Press Journal it was under control. A large-scale awareness campaign has been effective in educating people on how to protect themselves from Mpox, says Ainebyoona, a spokesperson for the health ministry.
The initial fear of the virus among people in the border towns has evaporated.
“People here are just mixing with each other as usual,” says Mariam Mbabu, a nurse at the Haki Medical Center in Uganda, just across the border. She adds that many people are unaware of how easily Clade I is transmitted.
Rosaria Masika, a Congolese woman who has been in Uganda for three months, said she went to a hospital in Bwera for antenatal care in July. There, she told a health worker that she had lesions on her body. The staff examined her and then sent her home for isolation.
There are no vaccines against Mpox in Uganda yet, says Dr. Amon Bwambale, health officer for Kasese district on the border with the Democratic Republic of Congo. Once they are available, he adds, pregnant women, children and people with immunodeficiencies will be given priority.
In the Democratic Republic of Congo, a vaccination campaign may be wishful thinking. On August 14, the World Health Organization declared the Mpox infection outbreak a “public health emergency of international concern,” a move intended to free up resources to stop the spread. The government of the Democratic Republic of Congo has authorized the use of Mpox vaccines, but they have not yet arrived.
The country has struggled in the past to deliver vaccines to those who need them. The Democratic Republic of Congo received millions of COVID-19 vaccine doses but had to send back 1.3 million of them in April 2021 because it could not deliver them to recipients, according to humanitarian aid group CARE. Only 60% of COVID-19 vaccination sites in the Democratic Republic of Congo were functional, CARE reported.
The country’s experience with COVID-19 does not bode well for the MPOX outbreak, and health experts around the world are watching the spread with concern.
“We feared that Mpox would spread like this,” says Malaty Rivera, “but it is not that shocking.”
In the meantime, Mwema and her family have nowhere to go. There are no signs that the decades-long conflict will end. The armed groups and the FARDC are known to act without regard for the people in the areas where they fight. For Mwema, safe alternatives are not just few, they are virtually nonexistent. For now, and possibly for many years to come, she will remain in the camp.